US9901348B2 - Mounting tool for an anastomotic device - Google Patents

Mounting tool for an anastomotic device Download PDF

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Publication number
US9901348B2
US9901348B2 US14/428,747 US201314428747A US9901348B2 US 9901348 B2 US9901348 B2 US 9901348B2 US 201314428747 A US201314428747 A US 201314428747A US 9901348 B2 US9901348 B2 US 9901348B2
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United States
Prior art keywords
connecting rod
anvil
head portion
intestine
distal head
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US14/428,747
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US20150230798A1 (en
Inventor
Anders Grönberg
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Carponovum AB
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Carponovum AB
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00818—Treatment of the gastro-intestinal system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1103—Approximator
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1132—End-to-end connections

Definitions

  • the present invention relates to a mounting tool for an anastomotic device, and more particularly, the present invention refers to a mounting tool for arranging an anastomotic device in the side wall of an intestine. Furthermore, the invention relates to a method for mounting the device to a tubular structure.
  • Colorectal cancer is the third most frequent type of cancer in the world having an occurrence of about 1 million new cases every year. The incidents of cancer are considerably more frequent in the industrial part of the world.
  • the leakage incident may be reduced and fatal consequences of anastomotic dehiscence can be avoided.
  • the inconvenience for the patient is obvious, since the patient must have a temporary stoma for a time period of about 3 to 6 months, and then has to undergo a second surgery in order to close the stoma.
  • the closure of the stoma cannot be reversed and the patient is forced to live with a permanent stoma leading to lower quality of life associated with increased costs.
  • surgical staplers create a smaller and more rigid opening compared to the cross section of the original lumen due to the staples inside the hollow structure connecting the two ends thereof, i.e. a collar may be formed that may lead to stenosis.
  • WO 2007122223 wherein an assembly comprising interlocking members for use in achieving anastomosis of tubular organs is disclosed.
  • the assembly comprises two rigid parts, onto which two elastic rings are arranged, to secure intestine ends, respectively, in between each rigid part and corresponding elastic part, whereafter the rigid parts are interconnected via a connection member. It is however difficult to use such open end anastomotic rings for connecting the side of an intestine to another side or an open end, which is often called for due to tumours with difficult access.
  • the present invention preferably seeks to mitigate, alleviate or eliminate one or more of the above-identified deficiencies in the art and disadvantages singly or in any combination and solves at least the above mentioned problems by providing: an anvil for use in connection with a first member of an anastomotic device in the side wall of an intestine, said anvil comprising a distal head portion and a connecting rod extending proximally from the head portion; said distal head portion having a first member retaining means, being displaceable laterally and centrally between a first member locking position and a first member releasing position; a tool for use in connection with an anvil according to above for arranging an anastomotic device in the sidewall of an intestine, said tool comprising a receiving member for receiving the connecting rod of the anvil, and a seat for a second member of the anastomotic device, said seat being arranged circumferentially of said receiving member, and said receiving member being displaceable in relation to said seat; and a kit of parts comprising
  • FIG. 1 is a perspective and exploded view of an anastomotic device according to one embodiment of the present invention
  • FIG. 2 is a side and exploded view of an anastomotic device according to one embodiment of the present invention
  • FIG. 3 is a perspective view of an anvil according to one embodiment of the present invention.
  • FIG. 4 is a perspective view of a tool according to one embodiment of the present invention.
  • FIG. 5 is a perspective view of an anvil according to one embodiment of the present invention connected to a tool according to one embodiment of the present invention
  • FIG. 6 is a perspective view of an anvil according to one embodiment of the present invention connected to a tool according to one embodiment of the present invention
  • FIG. 7 is a cross sectional view of an anvil according to one embodiment of the invention arranged in a tool according to one embodiment of the present invention.
  • FIG. 8 is a cross sectional view of an anvil according to one embodiment of the invention arranged in a tool according to one embodiment of the present invention, with a close up on the interaction between the two.
  • a device 100 for connection to the side wall of an intestine is disclosed. This device 100 may then in turn be connected to another such device 100 , connected to the side wall of another part of this intestine, or it may be connected to another anastomotic device according to the prior art.
  • the device 100 for arrangement on the side wall of an intestine comprises a first member 10 and a second member 20 .
  • the first member 10 and the second member 20 are both of a generally hollow open configuration.
  • the first member 10 comprises an elastic part 11 and a rigid support part 12 , which is disclosed in FIG. 2 (wherein the elastic part 11 has been omitted for clearer view of the other parts).
  • the elastic part 11 is a substantial circular symmetric ring and is made as a compact body or as a tube, which may be filled with air, gas or fluid, and are made of an elastic polymeric material of for example 40 to 70 Shore.
  • the rigid support part 12 may be of a polymeric material, more specifically a biocompatible material and most specifically a biodegradable material, of a rigidity adequate to stabilize the elastic part 11 .
  • the elastic part 11 may for example be an elastic ring of a suitable polymeric or rubber material, such as an elastomer.
  • the elastic part 11 has a first and a second axial end.
  • the rigid support part 12 is arranged at the first axial end of the elastic part 11 .
  • the rigid support part 12 is also ring shaped, with one side thereof adapted to receive the elastic part 11 .
  • This side of the rigid support part 12 may then have an elastic part seat 13 .
  • the elastic part seat 13 may be concavely shaped to receive the convex axial end of the elastic part 11 .
  • the elastic part 11 may be attached to the rigid support part 12 through glueing or through over-moulding or co-moulding.
  • the affected part of the intestine is removed by cutting the intestine on a suitable distance on each side of the intestine.
  • the device according to FIGS. 1 and 2 allows for creating a connection through the side of one such free end.
  • the open end is first closed with sutures. Then the intestine is incised at a suitable position.
  • the device 100 is arranged on an anvil 300 , according to FIG. 3 .
  • the anvil 300 comprises a disc shaped head portion 301 , which is adapted in size and shape to hold the first member 10 around its periphery.
  • a connecting rod 302 for connection with a tool for arrangement of the second member 20 , extends axially from the head portion 301 .
  • An incision is made in the side wall of the intestine.
  • the disc shaped head portion 301 with a first member 10 arranged thereon, is inserted into the intestine. Subsequently, the side wall of the intestine is sutured, such that only the connecting rod 302 extends laterally away from the intestine.
  • the connecting rod 302 is then inserted a tool 400 for arrangement of the second member 20 , as illustrated in FIG. 4 .
  • the tool 400 comprises a connecting rod receiving member 401 .
  • the connecting rod receiving member 401 comprises a female part 402 , with leaves 403 that may snap fit around a locking flange 303 on the anvil 300 .
  • a corresponding locking ridge 404 is positioned, such that the connecting rod 302 may be inserted in the proximal direction into the connecting rod receiving member 401 to force the leaves 403 laterally and outwardly until the locking flange 303 passes proximally of the locking ridge 404 , where after the locking ridge 404 snaps back centrally.
  • the connecting rod receiving member 401 may be threaded in its proximal zone, such as to realize proximal movement of the connecting rod receiving member 401 in relation to a second member seat 405 , for receiving a second member 20 , in the distal end of the tool 400 , to thereby drag the anvil 300 into the tool 400 by twisting a twisting knob (not shown) at the distal end zone of the tool 400 .
  • the second member 20 comprises a first and a second axial end.
  • the first end of the second member 20 matches the shape of the second axial end of the elastic part 11 , such that an intestine wall may be uniformly distributed between the second axial end of the elastic part 11 and the second member 20 .
  • a connection member 30 is provided for connecting the first member 10 to the second member 20 .
  • the connection member 30 may be at least one male part 31 on the second member and at least one female part 32 on the first member 10 . In the embodiment disclosed in FIGS.
  • the male parts 31 on the second member 20 are pins 31
  • the rigid support part 12 on the first member 10 comprises corresponding female parts 32 in form of holes or slits 32 , such that the second part 20 may be brought into connection with the first part 10 by inserting the pins 31 into the holes or slits 32 .
  • the pins 31 on the second part 20 may comprise barbs 33 and the holes or slits 32 on the rigid support part 12 on the first member 110 may have flanges at their mouths, to interlock the first part 10 to the second part 20 at a suitable distance from each other, at which the pressure on the intestine squeezed between the elastic part 11 of the first member 10 and the second member 20 .
  • the second member 20 comprises an intestine interacting part 21 and a pin carrying and tissue cutting part 22 .
  • the intestine interacting part 21 and a pin carrying and tissue cutting part 22 are preferably made of a polymeric material, more specifically a biocompatible material and most specifically a biodegradable material.
  • the pins 31 extending from the pin carrying part 22 are preferably of a biocompatible metallic material, but rigid polymers are also envisioned.
  • the intestine interacting part 21 has a concave intestine/elastic part seat 23 at its first axial end, intended to face the intestine and the first member 10 , such that the round shape of the elastic part 11 , shaping the intestine in contact therewith, may sit on the second member 20 in a convenient way.
  • the intestine interacting part 21 has holes or slits 24 and said pin carrying part 22 is provided with the pins 31 .
  • the pins 31 are received in the holes or slits 24 , such that the pins are accessible to interact with the support part 12 of the first member 10 .
  • the pin carrying and tissue cutting part 22 is provided with a sharp cutting edge 25 , which will cut the intestinal tissue in between the first member 10 and the second member 20 , as the pins 31 penetrate the holes or slits 32 of the first member 10 .
  • the anvil 300 is dragged into the tool 400 until the first and the second member 10 , 20 interconnects.
  • the pins 31 will penetrate the wall of the intestine around the incision, where after they will enter the holes or slits 32 on the rigid support part 12 on the first member 10 .
  • the barbs 33 and the flanges 34 will interact to interlock the first member 10 to the second member 20 .
  • first member 10 and the second member 20 are connected to each other, radially inwards of the elastic part 11 , and the intestine wall is squeezed at a uniform pressure between the elastic part 11 of the first member 10 and the concave intestine/elastic part seat 23 .
  • This is all realized by twisting the twisting knob in the proximal end of tool 400 , until the anvil 300 is dragged into the tool 400 for cooperation between the first member 10 and the second member 20 , in accordance with above.
  • the cutting edge 25 has cut the intestinal tissue in between the first member 10 and the second member 20 when the anvil 300 has been brought into the tool 400 and subsequently into a position wherein the pins 31 penetrate the intestine wall and locks to the first member 10 , in accordance with above.
  • the cutting edge 25 is circular and may constitute the inner periphery of the second member 20 , but may simultaneously be larger than the circumference of the head portion 301 , such that the anvil 300 may be retracted from the intestine.
  • the cutting edge 25 When activated the cutting edge 25 is moved distally in relation to the first member 10 and the intestine interacting part 21 , to cut the intestine wall along the inner periphery of the first member 10 and the second member 20 .
  • the cutting edge 25 may be moved distally by being arranged on the seat 405 by a pusher 406 on a threaded shaft and then twisting yet another twisting knob (not shown) in the proximal ends of the tool 400 to make the cutting edge 25 via the pusher 406 move distally along the threads. It is also possible to have the pusher 406 suspended on a spring mechanism, such that when said spring is released, the pusher 406 will be thrown distally to cut the intestine.
  • the anvil 300 is provided with a first member retaining means 304 , extending laterally from the circumference of the head portion 301 .
  • the retaining means 304 interacts with a corresponding groove on the first member 10 , or locks the first member 10 from distal movement by positioning itself distally of the first member 10 .
  • the retaining means is displaceable centrally, so as to release the first member 10 from the head portion 301 and thus the anvil 300 .
  • the retaining means 304 comprises laterally extending blades, that extend centrally to the connecting rod 302 , and then proximally along the connecting rod. When the blades are pulled proximally, they will move centrally from the periphery of the head portion 301 to release the first member 10 .
  • the blades/retaining means are provided with protrusions 305 , such as knobs, such as weldings, at the proximal end thereof along the connecting rod 302 .
  • a ring 306 may be arranged laterally of the protrusions 305 , to facilitated proximal displacement of the protrusions and thus central withdrawal from the periphery of the head portion 301 .
  • the retaining means 304 is in turn connected to a sleeve 307 , for example by clamping the retaining means 304 between the ring 306 and the sleeve 307 .
  • the sleeve 307 is arranged displaceably on the connecting rod 302 .
  • a locking flange 308 is positioned at the proximal end zone of the sleeve 307 .
  • a retaining means 304 interacting member such as a retaining means connector 407
  • a retaining means connector 407 will be brought into cooperation with the retaining means 304 , such that subsequent proximal movement of the cutting element and/or the connector 407 , will pull the retaining means 304 proximally along the connecting rod 302 to central withdraw the retaining means 304 from the periphery of the head portion 301 for releasing the first member 10 .
  • the retaining means connector 407 may for example comprise a distal locking lip 408 that may be forced outwardly and laterally when being pushed by the locking flange 308 , while the anvil 300 is moved proximally into the tool 400 .
  • the retaining means connector 407 may be displaceable proximodistally with regard to said second member seat 405 , to move the retaining means 304 from a first member locking position to a first member releasing position.
  • the pusher 406 is displaced proximally in relation to the first member 10 and the second member 20 .
  • the connector 407 will pull the retaining means 304 proximally to release the first member, and thus also the second member 20 now connected to the first member 10 , from the anvil 300 .
  • the pusher 406 and the connector 407 may be arranged on a threaded shaft in accordance with above, such that they may be displaced proximally by a twisting action.
  • the device 100 When the anvil 300 is subsequently retracted from the intestine, the device 100 has been securely arranged in the side wall of an intestine, and the intestine tissue removed from the lumen of the device 100 . In this position, the device 100 may be connected to another device 100 through the use of a separate connector or to an anastomotic device according to the prior art WO2007122223.
  • the separate connector may have a generally hollow open configuration.
  • the separate connector may provided slits extending axially from the free ends thereof around the periphery forming tongues between the slits. Centrally of the slits and tongues a central tubular part is arranged.
  • At least one of the tongues on each side is provided with an outward protrusion arranged adjacent or at a distance from the free ends of the tongues.
  • the central tubular part may be provided with through holes that may be connected to catheters.
  • the catheters have a length allowing for following the intestine out through the anus of the patient, such that air or water may be pushed through the catheters to check the sealing pressure between the elastic parts 11 , with accommodated intestine walls there between.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Physiology (AREA)
  • Surgical Instruments (AREA)
US14/428,747 2012-09-20 2013-09-12 Mounting tool for an anastomotic device Active 2034-08-22 US9901348B2 (en)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
SE1251060-8 2012-09-20
SE1251060 2012-09-20
SE1251060 2012-09-20
PCT/SE2013/051065 WO2014046596A1 (en) 2012-09-20 2013-09-12 A mounting tool for an anastomotic device

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US20150230798A1 US20150230798A1 (en) 2015-08-20
US9901348B2 true US9901348B2 (en) 2018-02-27

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US (1) US9901348B2 (ko)
EP (1) EP2897533B1 (ko)
JP (1) JP6216794B2 (ko)
KR (1) KR102105572B1 (ko)
CN (1) CN104661603B (ko)
AU (1) AU2013318679B2 (ko)
BR (1) BR112015006167B1 (ko)
CA (1) CA2885268C (ko)
DK (1) DK2897533T3 (ko)
ES (1) ES2706069T3 (ko)
HK (1) HK1210931A1 (ko)
MX (1) MX368354B (ko)
PL (1) PL2897533T3 (ko)
SG (1) SG11201502061PA (ko)
TW (1) TWI626922B (ko)
WO (1) WO2014046596A1 (ko)

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Publication number Priority date Publication date Assignee Title
US12114858B2 (en) 2019-05-07 2024-10-15 Easyflomicro Inc. Apparatuses for anastomosis of tubular vessels and related methods

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0517488A1 (en) 1991-06-03 1992-12-09 Ethicon, Inc. Absorbable anastomosic fastener means
US6503259B2 (en) * 2000-12-27 2003-01-07 Ethicon, Inc. Expandable anastomotic device
WO2004008936A2 (en) 2002-07-22 2004-01-29 Niti Medical Technologies Ltd. Anastomosis ring applier
US20040195289A1 (en) * 2001-10-05 2004-10-07 Ernie Aranyi Tilt top anvil for a surgical fastener device
WO2007122223A1 (en) 2006-04-21 2007-11-01 Carponovum Ab A device and a method for anastomosis
US7527185B2 (en) * 2006-07-12 2009-05-05 Niti Surgical Solutions Ltd. Compression anastomosis ring assembly and applicator for use therewith

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US4893622A (en) * 1986-10-17 1990-01-16 United States Surgical Corporation Method of stapling tubular body organs
US4907591A (en) * 1988-03-29 1990-03-13 Pfizer Hospital Products Group, Inc. Surgical instrument for establishing compression anastomosis
US5562690A (en) * 1993-11-12 1996-10-08 United States Surgical Corporation Apparatus and method for performing compressional anastomoses
ES2385522T3 (es) * 2002-10-04 2012-07-26 Tyco Healthcare Group Lp Dispositivo de grapado quirúrgico
JP2004147969A (ja) * 2002-10-31 2004-05-27 Univ Waseda 吻合装置及び吻合具
EP2769686A1 (en) * 2003-09-01 2014-08-27 Covidien LP Circular stapler for hemorrhoid operations
DE602006012054D1 (de) * 2006-10-06 2010-03-18 Ethicon Endo Surgery Inc Anastomosenapplikator
CN101332102A (zh) * 2007-06-27 2008-12-31 苏州天臣国际医疗科技有限公司 圆管型装订装置
US8685046B2 (en) * 2008-08-05 2014-04-01 Covidien Lp Magnetic compression anastomosis device
TWI491376B (zh) * 2009-04-28 2015-07-11 Jianzhong Shang Circumcision
US8496157B2 (en) * 2011-02-18 2013-07-30 Covidien Lp Tilting anvil for annular surgical stapler

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0517488A1 (en) 1991-06-03 1992-12-09 Ethicon, Inc. Absorbable anastomosic fastener means
US6503259B2 (en) * 2000-12-27 2003-01-07 Ethicon, Inc. Expandable anastomotic device
US20040195289A1 (en) * 2001-10-05 2004-10-07 Ernie Aranyi Tilt top anvil for a surgical fastener device
WO2004008936A2 (en) 2002-07-22 2004-01-29 Niti Medical Technologies Ltd. Anastomosis ring applier
WO2007122223A1 (en) 2006-04-21 2007-11-01 Carponovum Ab A device and a method for anastomosis
US7527185B2 (en) * 2006-07-12 2009-05-05 Niti Surgical Solutions Ltd. Compression anastomosis ring assembly and applicator for use therewith

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US20150230798A1 (en) 2015-08-20
MX2015003463A (es) 2015-06-22
BR112015006167A2 (pt) 2017-07-04
EP2897533B1 (en) 2018-10-17
EP2897533A1 (en) 2015-07-29
EP2897533A4 (en) 2016-06-08
HK1210931A1 (en) 2016-05-13
JP2015532852A (ja) 2015-11-16
JP6216794B2 (ja) 2017-10-18
CN104661603B (zh) 2017-09-22
CA2885268C (en) 2020-07-07
KR102105572B1 (ko) 2020-05-29
MX368354B (es) 2019-09-30
DK2897533T3 (en) 2019-02-04
TWI626922B (zh) 2018-06-21
CA2885268A1 (en) 2014-03-27
CN104661603A (zh) 2015-05-27
AU2013318679B2 (en) 2017-12-21
WO2014046596A1 (en) 2014-03-27
PL2897533T3 (pl) 2019-05-31
SG11201502061PA (en) 2015-05-28
ES2706069T3 (es) 2019-03-27
TW201420070A (zh) 2014-06-01
KR20150068401A (ko) 2015-06-19
AU2013318679A1 (en) 2015-04-30
BR112015006167B1 (pt) 2021-06-29

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